Letter | Carta
A realistic human model to teach physicians how to
Author
Marcus G. Bastos 1,2,3
1
Universidade Federal de Juiz de
Fora, Programa de Pós-Graduação
em Saúde, Juiz de Fora, MG, Brazil.
2
Faculdade de Ciências Médicas e
da Saúde, Juiz de Fora, MG, Brazil.
3
Centro Universitário Governador
Ozanam Coelho, Faculdade de
Medicina, Ubá, MG, Brazil.
Submitted on: 03/20/2023.
Approved on: 05/31/2023.
Published on: 07/24/2023.
Correspondence to:
Marcus G. Bastos.
Email: marcusbastos7@gmail.com
DOI: https://doi.org/10.1590/2175-
8239-JBN-2023-0034en
502
diagnose ascites using point-of-care ultrasound
Simulação realista para o ensino do diagnóstico de ascite
por ultrassonografia point of care
Dear Editor,
The use of point-of-care ultrasound
(POCUS) relies on three words beginning
with the letter I: 1. Insonation, or
the acquisition ultrasound images; 2.
Interpretation, when the attending physician
interprets the acquired images during a
patient encounter; and 3. Integration,
when the new clinical data is added to
the knowledge previously acquired via
investigation, palpation, percussion, and
auscultation, thus enhancing the accuracy of
physical examination. Ascites is a relatively
common finding in patients with kidney
disease in a variety of clinical contexts1
and its diagnosis should be included in
POCUS training programs in nephrology2.
Actors are often used in POCUS training
programs to simulate different clinical
Figure 1. Anechoic image in the right upper quadrant
showing free fluid in Morrison’s pouch, acquired from a
patient with two liters of dialysate in the peritoneal cavity.
L: liver; K: kidney with signs of chronic disease; FF: free fluid.
situations. In this human model of ascites
simulation, we have used clinically stable
patients on peritoneal dialysis (PD) in our
training sessions. On the day of the hands-
on session, the patient is advised not to
drain the peritoneal cavity after the last PD
cycle, thus keeping approximately 2 liters of
intraperitoneal dialysate. We use a convex
low-frequency ultrasound transducer (2–5
MHz) connected to portable ultrasound
equipment (VERSANA ACTIVE, GE) and
insonation is performed with the actor in
dorsal decubitus. The windows used in
the identification of the anechoic image
corresponding to free intraperitoneal fluid
are the right upper quadrant (Figure 1),
pelvis, and left upper quadrant. This
protocol allows the representation of ascites
in the described windows in 100% of the
simulations performed. In summary, the use
of patients undergoing dialysis with dialysate
in the abdominal cavity provides a realistic
model for simulating ascites in point-of-care
ultrasound training in undergraduate and
graduate medical education programs.
Conflict of Interest
None to declare.
References
1. Ackerman Z. Ascites in nephrotic syndrome:
incidence, patients’ characteristics, and
complications. J Clin Gastroenterol. 1996;22(1):
31–4. doi: http://dx.doi.org/10.1097/00004836-
199601000-00009 PubMed PMID: 8776092.
2. Hoppmann RA, Mladenovic J, Melniker L, Badea
R, Blaivas M, Montorfano M, et al. International
consensus conference recommendations on
ultrasound education for undergraduate medical
students. Ultrasound J. 2022;14(1):31. doi:
http://dx.doi.org/10.1186/s13089-022-00279-1
PubMed PMID: 35895165.